| NPI | 1205105806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95012960) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.0991374-NP) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 305918) | |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2020-12-04 |